What should I not do when appealing a decision by my PPO or HMO?
In the review process to your PPO or HMO, you want to make sure again you don't adapt the terms they're trying to deny you by. So you don't want to tell them it's a psychological disease when in fact anorexia has a medical component, too. You don't want to say it's experimental when you don't even understand what their definition is and you may not be having an insurance language experimental procedure. So you just have to be careful to not use their terms and use the broad brush that they have to describe your own individual situation. You also have to be determined to not show them you're willing to go away. So many people call and say, "I'm sure you don't want to pay for this and you're not going to pay for this, but would you think about paying for this?" Right away that shows that you're weak, that you're willing to give up and they're going to say no. So you have to be poised in showing the insurance company you're willing to fight to your death for the procedure if it's that important. In the review process it's real important to say, "My doctor recommends this. My doctor says this.", because you have to remember you are not the medical expert. Don't allow the insurance company to make you a medical expert, asking you to define terms and requests. So the best approach to take with the insurance company in a review process is to use the doctor's language, "My doctor has recommended this. You gave me this doctor. You paid for this doctor. I'm trying to follow your doctor's advice." So make your own doctor their doctor, and that really can help your arguments. But try not to be turned into, even if you have some medical background, try not to be turned into a neurosurgeon. Try not to be turned into a world renowned cancer expert, because you're just following the advice of well-schooled experts. Don't let your PPO or HMO try to define terms with you and against you or label you.
